# A client with sickle cell disease is hospitalized for a vaso-occlusive pain episode. The client develops a temperature of 38.6 C, new chest pain and cough, and an oxygen saturation of 88% on room air. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with sickle cell disease is hospitalized for a vaso-occlusive pain episode. The client develops a temperature of 38.6 C, new chest pain and cough, and an oxygen saturation of 88% on room air. Which action should the nurse take first?

## Option

1. Apply oxygen and notify the health care team for urgent evaluation **✔ Correct answer**
2. Give the prescribed oral opioid and reassess the pain in one hour
3. Encourage oral fluids and repeat the oxygen saturation after ambulation
4. Use the incentive spirometer and wait for the scheduled chest radiograph

**Correct answer: 1**

## Explanation

Fever, new chest symptoms, and hypoxemia in sickle cell disease suggest acute chest syndrome, a potentially life-threatening complication. Oxygen support and urgent team evaluation take priority over routine pain treatment, ambulation, or delayed testing.

## In-depth explanation

Quick answer
Apply oxygen and obtain urgent evaluation. The pattern suggests acute chest syndrome with current hypoxemia.

Why this is correct
Acute chest syndrome can worsen rapidly and may require hospital treatment such as oxygen, antibiotics, and transfusion. Supporting oxygenation while urgently escalating the new respiratory findings addresses the immediate threat.

Easy analogy or mental picture
The new chest findings are like a warning light showing that a pain crisis has moved into the lungs. Oxygen and urgent evaluation respond to that warning, but the analogy does not establish the final diagnosis or replace imaging and laboratory assessment.

Memory hook
Sickle cell disease plus fever, chest symptoms, and low oxygen means suspect acute chest syndrome and act urgently.

NCLEX decision rule
When a client with sickle cell disease develops new respiratory symptoms and hypoxemia, prioritize oxygenation and urgent escalation for possible acute chest syndrome. Do not let the existing pain diagnosis hide a new airway or breathing threat.

Why the other choices are wrong
An oral opioid does not treat the respiratory emergency. Ambulation can increase oxygen demand, and incentive spirometry alone should not delay urgent assessment when hypoxemia and new chest symptoms are present.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]NHLBI: Sickle Cell Disease Symptoms and Acute Chest SyndromeNational Heart, Lung, and Blood Institute

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A nurse is caring for a client prescribed Digoxin. Which nursing action is most appropriat…](https://mymerci.kr/pages/nclex_q.php?qn_id=375157&lang=en)
- [A nurse is caring for a client prescribed Lithium. Which nursing action is most appropriat…](https://mymerci.kr/pages/nclex_q.php?qn_id=375233&lang=en)
- [A nurse is caring for a client prescribed Spironolactone. Which nursing action is most app…](https://mymerci.kr/pages/nclex_q.php?qn_id=391869&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=498696&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._